Malaria

Malaria is responsible for over 800,000 deaths every year. According to statistics from the World Health Organisation (WHO), malaria is responsible for claiming the life of a child every 45 seconds. The disease has a long history and there are written reports of similar fevers appearing as early as 6000 BC. It is a common and widespread disease, especially prevalent in the tropics. 

Malaria is believed to have originated in Africa from where it spread all over the globe. It has emerged as one of the worst killer diseases to have affected mankind. Studies have shown that all species of malaria have probably migrated from the great apes to man. The type P.falciparum is believed to have originated from gorillas. There are approximately 500 million cases of malaria each year of which 85% occur in sub-Saharan Africa and of all the cases of malaria that occur in Africa, about 85% are caused by a single strain of malaria called P.falciparum.

What Is Malaria?

Malaria is a common disease that can be life-threatening. It is widespread in many countries of the tropics and subtropics of Africa, Asia, and South America. It is caused by the parasite Plasmodium. Five species of the Plasmodium are known to cause malaria P. falciparum, P. vivax, P. ovale, P. knowles and P. malariae.  The parasite is transmitted to humans through the bite of a female Anopheles mosquito (which is the carrier or vector for the disease). Once the parasite enters the human bloodstream, it grows and multiplies in the liver and then begins to infect and destroy the red blood cells.

Although there are many species of Plasmodium parasite, only five species are known to infect humans and cause the disease. Out of these, the, two types are the most dangerous- P. falciparum and P. vivax. Here are the 5 types of Plasmodium parasite:

• P. falciparum
  It is mostly found in the tropical and the subtropical regions and is one of the major causes of death.
• P. vivax
  It is commonly found in Asia and Latin America. This kind of malaria can remain dormant in the liver for years and can activate at any time.
• P. ovale
  It is found in Africa and the Pacific islands.
• P. malariae
  This variant of the parasite is found worldwide and can cause chronic infection
• P. knowles
  It is found in Southeast Asia and can progress rapidly. This malarial species infects primates and has led to human malaria.

P. ovale and P. malariae represent only a small number of infections worldwide.

On the basis of the severity of the infection and how fast it spreads, malaria is divided into two types:

• Uncomplicated Malaria
  Malaria is considered to be uncomplicated when the symptoms are not specific and are similar to those of flu. It is not a severe infection and there is no vital organ dysfunction. Uncomplicated malaria can be caused by all 5 types of malarial parasite.
• Severe Malaria
  This is usually caused by P. falciparum. Infection with P. falciparum usually begins as uncomplicated malaria. However, if it is not treated in time, it can quickly progress to severe malaria. The symptoms of severe malaria include difficulty in breathing, low sugar levels, and severe anemia amongst other indications. Children are more prone to severe malaria as they have low levels of immunity. Though the falciparum strain is one of the main strains that escalate to severe malaria, recent studies have shown that P. vivax and P. knowlesi can also cause a severe form of the disease.

The symptoms of malaria are classified into two categories - uncomplicated and severe. 

Symptoms of Uncomplicated Malaria

Uncomplicated malaria usually shows all the typical symptoms of malaria, but these symptoms are not accompanied by symptoms of severe infection and damage to the vital organs of the body.

Uncomplicated malaria, when left untreated, can progress to severe malaria. Severe malaria can also occur if a person has very low immunity. Malarial symptoms last for a span of 6 to 10 hours and then repeat themselves every second day. These symptoms can vary depending on the type of the parasite causing it and can result in mixed symptoms at times.

The progression of symptoms in uncomplicated malaria is as follows:

• Feeling of cold accompanied with shivering.
• High fever, headaches, and vomiting.
• Younger patients may sometimes get seizures.
• Sweating followed by the disappearance of fever and feeling of tiredness and exhaustion. (Read more - Fatigue)

Symptoms of severe malaria

In Severe malaria, there are signs and symptoms that indicate damage to vital organs of the body.

Some of the characteristic symptoms of severe malaria are:

• Fever and chills.
• Problems with consciousness along with decreased awareness and wakefulness.
• A tendency to lie down in a prone position (lying down with chest down and back up).
• Deep breathing and difficulty in breathing.
• Signs of anemia like feeling exhausted and generalized weakness.
• Signs of jaundice, for example, yellowing discoloration of white areas of eyes and nails along with, excessively yellow urine.

Severe malaria can even result in loss of life if it is not treated.

The symptoms of malaria are similar to the symptoms of common flu or a viral and the diagnosis is difficult in people who are not prone to the disease.

Causes

The direct cause of malaria is a bite from an infected female Anopheles mosquito. The parasite is passed into the human bloodstream where it multiplies in the liver of the infected person for an average of 10 days. The person initially shows no signs of infection and symptoms during the first few days. The malarial parasite then infects the red blood cells and begins to multiply further. Some of the malarial parasites remain in the liver and are not released into the bloodstream until the later stage of the disease. This leads to recurring malaria. Malaria also breaks out in areas which have existing malaria patients. This is because as the uninfected mosquito that bites an infected individual becomes infected with the parasite and thereafter spreads the disease. The growth of the parasite within the mosquito depends on certain environmental factors such as humidity and the temperatures of the area.

Risk Factors

Malaria is often prevalent in places inhabited by people belonging to a lower socio-economic class. The people in such places often lack access to necessary amenities including bed nets and windows with mosquito screens that can protect them from mosquitoes. They often lack adequate knowledge take preventive spread that can stop mosquitoes from breeding in the surroundings, for example:

• Certain professions such as the jobs in agriculture sector make the workers more vulnerable to mosquito bites and increase their risk of contracting the disease.
• Allowing water to stagnate during the rainy season in the surroundings such as potholes, flower pots, water coolers can act as breeding grounds of mosquitoes and increase mosquito population.
• Failure to use adequate protection from mosquito bites increases chances of contracting the disease. This may occur because people do not use mosquito repellents or they wear clothes that expose them to mosquito bites. Lack of proper knowledge, high costs or simple inconvenience are some of the reasons behind the failure of individuals to protect themselves from this disease. 
• Control of malaria in endemic countries depends to a large extent on the effectiveness of malaria control activities. An absence of effective and efficient regulatory control measures increases the risks of malaria.

It is possible to reduce the risk of malaria by taking extra precaution both indoors and outdoors. Here are ways to prevent a malarial infection:

• Protection and prevention from mosquito bites
  People living in mosquito infected areas or travelling to such areas should protect themselves from mosquito bites. Staying in AC rooms, use of mosquito repellents, wearing clothes that cover the body and avoiding places that are harbour stagnant water helps to reduce the risk of being bitten by mosquitoes. We should be aware of the risk of malaria, and the fact that symptoms may A tendency. Immediate diagnosis and treatment should anemia after if symptoms appear.
• Mosquito control
  Preventing the mosquitoes from breeding is one of the most important ways to prevent the spread of the disease. Spraying of insecticides, preventing water logging in open spaces and destroying unwanted sources of stagnant water, storing water in closed containers, and destroying the breeding larvae and pupae can help to control the mosquito population. Use of insecticides or breeding of guppy or Gambusia fish that eat the larvae and pupae in open water sources such as lakes or ponds are effective methods to eliminate the mosquito larvae.

Malaria is diagnosed by the doctor based on symptoms and blood tests. Clinical for example indicate the presence of a malarial infection while blood tests confirm the diagnosis. The common symptoms of malaria such as high fever, sweats, chills, headaches, muscle pain, nausea, and vomiting are also found in other common diseases such as flu and viral infections. In places where malaria is common, doctors routinely prescribe a blood test to detect the presence of malaria parasites in the blood.

The different types of blood tests are:

• Thick and thin blood smears
  These are the most common and accurate tests conducted to test the presence of malaria parasites in your blood. It should be noted that the number of parasites in the blood can change each day and a single negative test does not rule out malaria. Multiple tests over several days may be required before a confirmed diagnosis can be stated.
• Rapid Diagnostic Test
  Also known as the antigen test, this kind of diagnostic testing is conducted when there is limited access to tools for blood smearing and testing. It is a quick test that detects the presence of antigens in the bloodstream. In case the test is positive a smear test must be conducted.
• Molecular Test
  The molecular test helps to identify the specific type of parasite that acted as the causative agent. It is also known as the polymerase chain reaction (PCR) test and is usually recommended if the results of the blood smears are vague.
• Antibody Test
  Antibody tests are conducted to rule out any previous history of malarial infection.
• Drug Resistance Tests
  Sometimes the malarial parasites become resistant to drugs. When this happens doctors may order this test to check the drug sensitivity of the infecting pathogen.
• Blood Count and Chemistry Panel:
  This test is conducted to determine the severity of the malarial infection and if it has caused other problems such as anemia or kidney failure.

Detection of the presence of malaria parasite becomes difficult in countries where the disease is uncommon. This is because doctors may not be familiar with the disease and may not consider it as a possibility. Moreover, diagnostic technicians may lack the experience to detect the presence of malarial parasites. Diagnosis becomes even more difficult because the symptoms appear after a period of two weeks and travellers who travel to places where malaria is prevalent forget to mention their travel to the doctors.

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Antimalarial drugs are classified, anti-malarial activity and chemical structure. These are:

• Tissue schizonticides
  These drugs act on the parasite present in the liver and prevent them from multiplying. Malaria cannot be generally treated with these drugs alone because the symptoms of malaria only appear after the parasite has multiplied and begun destruction of red blood cells. It is practically impossible to predict the presence of an infection before the symptoms begin.
• Tissue schizonticides for relapse
  These drugs act on certain strains of the parasite present in the liver that triggers the relapse of malaria.
• Blood schizonticides
  These drugs act on the blood forms of the parasite and are the most important anti-malarial drugs.
• Gametocytocides
  These drugs act on the sexually matured parasite in blood and prevent the spread of infection to other mosquitoes that bite an infected person. Some drugs belonging to this category are effective against all kinds of malaria while other drugs work only on certain strains of the parasite.
• Sporontocides
  These drugs stop the formation of oocysts in the mosquito and stop the spread of infection.
• Combination therapy
  An effective malarial treatment includes a combination therapy using various drugs that act simultaneously on the parasites present in the liver and the blood along with drugs that stop the spread of infection. It is the simultaneous use of two or more drugs with different modes of action that target different parts of the parasite. This kind of treatment regimen shortens the time of treatment and decreases the risk of resistant parasites arising.

The combination of medicines prescribed depends upon a number of factors such as the type of infection, the severity of infection, the physical condition of the patient and associated conditions and diseases. People infected with the P. falciparum need to be thoroughly checked and examined as it is a relatively serious and has a possibility of resistance to anti-malarial drugs. A patient with pregnancy needs to be administered a different combination of drugs as certain malarial drugs are not safe for pregnant women. Doctors need to check for the existence of medical conditions such as epilepsy, cardiac disease, renal failure and dermatitis as these patients require either a different combination of medication or medication of different strength.

Lifestyle management

Certain lifestyles that expose individuals to mosquitoes are one of the, when left untreated, factors that lead to contracting the infection. Minimal or zero exposure to mosquitoes reduce and eliminate the risk of infection. Apart from the prevention of exposure to mosquitoes, lifestyles have little role in malarial infections.

Prognosis

Malaria is completely treatable if it is diagnosed in time and the correct medication is provided to patients. Complications in malaria arise mainly because of lack of proper and timely treatment. Lack of diagnostic facilities and availability of treatment is one of the major reasons for mortality in this disease.

Complications

Malaria is a treatable infection and can cause complications only if it is left undiagnosed and untreated in time. Escalation of uncomplicated malaria into severe malaria can lead to dangerous consequences.